Supported Employment Service – Southdown Housing

Southdown’s Sussex-wide specialist Supported Employment team support people with severe and enduring mental health needs to secure and retain paid work and complete education, training and work placement opportunities. Employment Specialists work in partnership with NHS Mental Health Recovery Teams to provide tailored support for individuals based on their needs, goals and aspirations. The team is the largest provider of specialist IPS (Individual Placement and Support) employment support in the UK, and is recognised by the Centre for Mental Health as an IPS Centre of Excellence. It supports 1,200 people a year.

Co-Production

From start: No

During process: Yes

In evaluation: Yes

Evaluation

Peer: Yes

Academic: Yes

PP Collaborative: Yes

Find out more

What We Did

Southdown’s Sussex-wide specialist Supported Employment team support people with severe and enduring mental health needs to secure and retain paid work and complete education, training and work placement opportunities.

Employment Specialists work in partnership with NHS Mental Health Recovery Teams to provide tailored support for individuals based on their needs, goals and aspirations.

The team is the largest provider of specialist IPS (Individual Placement and Support) employment support in the UK, and is recognised by the Centre for Mental Health as an IPS Centre of Excellence. It supports 1,200 people a year.

The team work extremely hard to support clients to overcome barriers and challenges in their journey to employment, often including low self-confidence, as well as external factors of low expectation, stigma and discrimination regarding their mental health condition.

Once in work, clients continue to be given support to sustain their jobs, including individual wellness plans and intensive support to them and their employers during periods of ill health.

The team has also recently developed an ‘Employment Retention Model’ following an increase in demand for support to enable people with severe mental health issues to stay in their jobs (referrals have doubled over the past two years).

Our Supported Employment team provide an enhanced offer to clients, beyond securing and sustaining work, which considers the wider health and social issues that impact upon their lives. We have helped people to become more socially active and independent alongside work and have contributed towards their increased wellbeing and social capital gain. We have challenged their own stigma and the raised their aspirations, and have supported people to take positive steps with their recovery and wellbeing.

Winning this award would be recognition of the importance that work plays in giving better life opportunities, improving independence and self-esteem for people with mental health issues. With specialist support, clients can enter or maintain work despite their health challenges and play an active economic and social role in society. Client of the service said, “I’d been out of work for eight years to care for my partner who was dying of cancer. I didn’t cope well with it. It got to the point where I was feeling better in myself and I knew I wanted to get back into work but I didn’t know how. After seeing my Employment Specialist, I felt different. I smiled more. I’m more confident. I’d given up before; I’d even thought about taking my own life several times. The biggest achievement was getting this job. All I wanted was a chance. I’ve never doubted how hard I would work. This experience has made me realise how important support is. I’m more likely to ask for what I need now, to admit I have trouble with things. I’ve learnt not to give up and to trust people.”

Our team of Employment Specialists have told us of their sense of pride and privilege about the role they are doing and how their own awareness and empathy around mental health in general has increased. Some have confessed that despite their optimism, the progress and achievements of clients has been at times overwhelming, but always inspirational. In all of the locations we work we have challenged the stigma and discrimination surrounding mental health and have stimulated conversations about good mental health and what people can achieve instead of what they can’t.

One of our Employment Specialist said, “Seeing the achievements of our clients is inspiring. Southdown provides an environment where staff can flourish and in turn support clients to excel.”

Wider Active Support

Our Employment Specialists work continuously with other services and partner organisations to better support our clients. This is done through informal and formal pathways, networking events as well as meetings, forums and general conversation

Sussex Partnership Foundation Trust:

Our main partnership is with the Sussex Partnership Foundation Trust (SPFT) where we have established relationships from Board to frontline delivery. We have a positive working relationship and ongoing and open communication in which we regularly review activities and discuss new and innovative ways of working for the benefit of our shared clients.

By being co-located within NHS clinical teams we have introduced a different way of thinking. We have worked with individual clinicians and presented to professional groups, as well as given talks at clinical team meetings about our work and the principles of IPS.

Through this we have contributed to changing the culture and expectations of both clinicians and clients and have raised aspirations about and for people with severe and enduring mental health difficulties and their ability to sustain mainstream employment.

As well as supporting clients, our Employment Specialists also attend a number of groups and SPFT activities to promote our services to as many clients as possible. This includes attending in patient units, contribution to the ‘Vocational through Activities’ group and giving talks to client and professional groups.

Our local Job Centres are another partner we work proactively with. Locally our Employment Specialists have built up relationships with Job Centre Plus advisors to increase referrals and accessibility to our service, and equally so we can best support our clients when they make the transition into work and/or need to engage with the Job Centre.

At a management level we also maintain beneficial working relationships with Job Centres and have, for example, recently arranged for our workers to be able to use desk space within specific job centres so that we have a visual presence and can increase our relationships and accessibility.

We have also attended joint caseload conferencing meetings with Job Centre staff and their local/regional Employment Psychologist.

“It’s great to have our joint case conferencing. It’s really helpful to get the specialist input and knowledge from Southdown Staff” – ESA advisor

Recovery Colleges:

Throughout Sussex, Southdown and our Employment Specialists have contributed towards Recovery College steering groups and have co-delivered courses with peer workers. As well as the courses we deliver, we have also been guest speakers for other courses so that we can again promote our service and the success of some of our clients. We have contributed to the recovery colleges from an early stage and continue to be involved in their growth and deployment. We have also utilised this relationship in being able to secure clients course places and work opportunities with the colleges

“The input and knowledge that the Employment Specialists bring is invaluable and the client success stories they share can be truly inspirational to the students” – Peer Trainer

Employers:

Engaging with employers is a fundamental part of our work and again this is done at both a managerial and Employment Specialist level. We have engaged with a number of employers for individual clients to secure paid employment, work experience opportunities and to help clients sustain their employment. We have also worked in partnership with employers to help promote positive mental health in the work place and have delivered mental health awareness to both individual employers and to multiple employers who have attend our workshops and training. At our last mental health awareness session for employers we had approx. 30 employers attend our workshop. Examples including Mental Health Awareness training which has been delivered to ASDA’s Southern Regional People Managers, the Child Support Agency, Hastings Direct, Barclays Bank.

“It’s great to get this sort of information and know about this type of service” – Employer who attended our training

Centre for Mental Health:

Since 2011, we’ve been recognised and accredited by the Centre for Mental Health as an IPS centre of Excellence. We have maintained and nurtured our relationship with them for the benefit of the organisation and clients alike.

We have shared information and statistics with the Centre and their networks and are now considered to be one of the foremost Centres of Excellence for individual placement and support services. We continue to proactively liaise with the Centre to share best practice and gain from their expertise.

Third Sector Services:

Our Employment Specialists and management have built up and maintained relationships with a number of providers who can support our work with clients. This includes working with local recovery centres and community wellbeing services, IAPT services, recovery partners and peer services.

Colleges and Educational Providers:

We have worked with mainstream colleges and independent training providers who have run courses specifically for our clients as well as helped our clients integrate into mainstream courses and education.

Multi-agency Forums:

At different times and in different parts of the county, our Employment Specialists have facilitated and contributed to multi agency forums where we have brought together different representatives from a range of stakeholders in order to keep abreast of relevant services and information that will aid our clients and their vocational journeys. Through a recent forum we have been able to work in partnership with the Shaw Trust to secure approx. £500 worth of funding for a client to become self-employed.

We also have representatives who promote our work and integration with other services and county-wide initiatives. This includes being part of the West Sussex Mental Health Pathfinder Alliance, attendance at the strategic group for East Sussex Better Together and membership to the Brighton and Hove Employment and Skills Panel.

Co-Production

Client involvement plays an important part in our work. We are continually seeking feedback from our clients’ experiences to learn from and make improvements to the support we provide. We actively respond to feedback we receive to tailor the service to people’s needs and wants.

We seek clients feedback in a number of ways:

• Routinely we send out surveys and questionnaires for clients accessing our service enabling them to share their feedback electronically, face to face or in writing. Alongside this we regularly ask for informal feedback and use client stories and case studies to inform our practice and to encourage new referrals.

• As an evidence-based service, we are subject to regular independent quality ‘fidelity’ reviews where our Employment Specialists and their clients, clinical teams and practices are interviewed.

• Periodically we also hold client events where clients can share their views, experiences and opinions of the support they have received in an informal setting. In addition we also attend and contribute to a number of steering groups and service user networks where we can gain information and opinions on our services.

In addition we involve our clients in checking the quality of the service. Our Quality Consultants provide both general and specific feedback they have gained.

Staff are also encouraged to provide feedback and contribute to service delivery and development plans. We have a range of ‘Champions’ within our services and teams who help collate feedback and drive our service forward.

All this information is proactively and continuously sought and reviewed during decision making, planning and service delivery.

Looking Back/Challenges Faced

Historically there have been, and continue to be, some challenges related to us having co-located workers embedded within Sussex Partnership Foundation Trust offices. We continue to react positively to these challenges and through our relationships do not allow these to impact on our work, quality of service or quantity of results. To help with this we regularly review, and when required update, our Memorandum of Understanding.

The challenges we have faced have helped shape the service and demonstrated the resilience and professionalism of our staff, their commitment to their roles and the value placed upon our IPS service. Though difficult at times, it is these challenges and our ability to overcome them that has contributed to the service’s success.

Sustainability

The success of our service is primarily due to the skills and dedication of our Employment Specialists. Theirs is a unique role that requires a balance of three major skills: motivating clients, self-confidence to develop job opportunities and negotiate with employers and ability to integrate and work in often stressful and challenging environments within NHS Mental Health Recovery teams.

Southdown has an in-house training team who support new employees coming into the service, as well as existing staff, to deliver quality and tailored support to those in need. We also have robust processes and systems in place which ensure the smooth running of the service.

As staff within the service move on to other career opportunities, Southdown’s in-house recruitment team is called on to fill vacant posts. Wherever possible, we would support career development and progression within the team, and Southdown as a whole.

Evaluation (Peer or Academic)

As a Centre of Excellence for IPS we are subject to external Fidelity Reviews which evaluate every aspect of our service from individual workers to senior management, our delivery, integration with the Sussex Partnership Foundation Trust, outcomes and partnership working. We are considered exemplary when reviewed against the internally recognised evidence based model and are one of the country’s foremost Centres for Excellence.

Alongside this we complete our own internal fidelity reviews and audits which see some of our senior workers evaluating their peers. As with external reviews, these are carried out thoroughly and fairly and used as way of ensuring our practice meets the expectations of the IPS model

Through our internal Quality Consultants (volunteer quality checkers with lived experience of mental health) we have had different individuals and parts of our services reviewed and evaluated. This covers everything from general activity and engagement of our Employment Specialists, to the processes and procedures we follow. Reviews are carried out objectively and provide independent feedback, suggestions and comments which are used in a proactive way to help improve our service, results and our ability to support our clients achieve their vocational goals.

All of these reviews and the information gathered help inform service development and delivery.

Outcomes

Over the last 12 months (01/03/16 – 28/02/17) outcomes of the service include:

Since our inception we have seen a cultural shift within Sussex Partnership Trust and the expected achievements of their clients. We have seen clinicians move away from a medical model where they feel clients need to be ‘ready to work’, to a culture where those who would like to work are offered support regardless of their current level of wellness and/or work history.

Our presence within the clinical teams has helped to bridge the gap between specialist mental health services and community support and with this an increase in the opportunities for clients and clinicians alike.

Client stories (names have been changed to protect identity)

Sarah was self-referred to the Vocational Service after experiencing a period of depression. She was made aware of the vocational service by the Together Resource Centre and was keen to receive advice, guidance and practical support. Sarah had consistently worked and managed her health but found that there had been prolonged periods where she was unable to work.

The service supported Sarah to assess her own strengths and ambition and provided encouragement and reassurance to enable her to pursue her vocational goals. Although she had always worked, there had been periods without work and many years spent self-employed. The main priority was not simply to find another job but to find consistency and stability in work that would promote good wellbeing and allow Sarah to have a good work/life balance. Sarah is very employable and needed reminding of this and supported to consider alternate employment opportunities as well as encouragement to reevaluate her self-employment. She received regular advice and practical support and completed the ‘Work and Wellbeing’ course delivered by Southdown and the Recovery College. During her time being supported by the vocational service Sarah was made aware of, and completed, several personal development course as well as pursuing her own goals and voluntary roles. She has obtained several jobs and has always sought out opportunity which would complement her existing skills/needs and future goals. She has strived to make continued progress with both her employment and wellbeing. Her diversity of skills and experience meant Sarah had various employment options and she was assisted to reflect on the jobs she wanted and the local labour market. She was given reassurance and empowerment to pursue her goals and each time she secured employment she was offered in-work support and further advice to consider alternate work whilst in work.

Sarah has been working now consistently and at times has managed several different jobs alongside each other and she continues to development her own skills and experience for her own benefit and to assist those around her.

Sarah is truly an inspirational example of how to find the right job and use “stepping stones” in the form of vocational course, volunteering and paid employment to secure the right job. She continues to focus on the jobs at hand and her long term plan and she has renewed confidence and enthusiasm.

…………………

Mark is a long term client of the Vocational Service and has truly benefited from the ‘time unlimited’ approach. He first accessed the service after being referred by his Consultant within the Specialist Mental Health Team after a long period of unemployment.

The Vocational Service helped Mark review and reflect on his previous work experience and identify his transferable skills. It helped him secure voluntary experience and complete vocational courses including Southdown’s Work and Wellbeing course.

During his time being supported by the service Mark has secured paid employment, but a combination of ill health and unpredictable events have at times brought his employment to an end. Each time he has found it hard to reconsider new work and his recent experiences were additional barriers to overcome. At one time Mark secured employment for around 2 years but when this came to an end he re-referred back to the service for further support.

Often Mark has needed information about benefits when making the transition from work to benefits and vice versa and he has been supported through this process. Mark required encouragement and to acknowledge what skills he did possess and how to utilise his strengths when looking for, applying to and sustaining employment. He has received careers advice and vocational profiling and has now identified a new career path, secured new employment and is currently receiving in-work support to aid him in sustaining this employment.

Although there have been set-backs, Mark has demonstrated the ability to overcome difficulties and remain focused on his employment goals. Mark is an example of how looking for work and focusing on actions can help you overcome barriers to secure employment. We will continue to support him and provide in-work support

Sharing

Our team work hard to ensure their experience is shared with others so learning ripples outwards to contribute to best practice and better outcomes in much wider communities.

Through our joint working with Sussex Partnership Trust we regularly share the successes and challenges of our work. Our Employment Specialists attend weekly clinical meetings where they contribute towards clinical discussions. Employment is now a regular agenda item where we are able to talk about our role and promote good news stories. We provide written reports on our successes and outcomes as well as informal updates to senior management. As part of our joint Vocational Strategy with Sussex Partnership Trust we co-host meetings bringing together our Employment Specialists and the Trust’s Vocational Champions, along with our team managers and vocational leads to share county-wide experiences.

We arrange for clients to be part of group activities that we run so they can share their vocational journeys with other clients and professionals.

For our commissioners, we provide evidential information on our service and how we are meeting our contractual requirements alongside anecdotal information and client case studies.

The team are nationally recognised as industry leaders of specialist IPS employment support, and have for many years shared their experience and expertise with many other providers and commissioners across the UK. We host regular open days and offer training too as we believe in the importance of working together, learning from each other to help make best use of limited resources and working to the goal of creating better futures for the clients we support. As part of our commitment to sharing best practice and promoting the IPS model we have welcomed visitors from NHS England, NDTI and Dorset NHS Foundation Trust and Sheffield Housing Association. And, we have provided training and mentoring to the Poppy Factory to help them adapt and model their working around the IPS principals of supported employment.

In addition to our national reputation we are also a part of an international network, analysing data, sharing knowledge and recommending best practice. Currently we are partners in a long term study by the Head of Social Inclusion and Recovery Research, Professor Geoffrey Waghorn of the Queensland Centre for Mental Health Research in Australia.

Is there any other information you would like to add?

One of team’s proudest achievement over the last 12 months has been enabling our clients to have opportunities to actively share their experiences of mental illness and IPS support to promote best practice and influence national health and employment policy.

This has included contributing to the Local Government Association’s White Paper recommending a localised model of employment support. Clients shared their experiences of mental health challenges and the barriers they have faced securing, and staying in, work.

Clients joined staff to host visits from NHS England, The Work and Health Unit and the Department of Work and Pensions and joined discussions about effective service models. They also jointly hosted visits from providers from Sweden and Tokyo to share best practice.

After a productive year, clients were delighted that their input had contributed to the publication of the Government’s Green Paper (Improving Lives); a blue print for changing future employment and health provision.

The eloquence and passion of clients as they have shared their experiences has been amazing. It means a lot to be able to do something that can make a difference for others.

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